Monthly Archives: January 2013

U.S. death rate from cancer is dropping

Author: Sean Patterson

Though cancer hasn’t been completely cured, it’s clear that treatments for the disease have improved over the past two decades. A yearly report from the American Cancer Society has shown that the death rate from cancer in the U.S. is declining among all Americans and for the most common types of cancer.

The report, published recently in the Journal of the National Cancer Institute, shows that the death rate from all cancers combined has been falling since the early 1990. From 2000 to 2009, combined cancer death rates have fallen an average of 1.8% among men and 1.4% among women. Black men and black women saw the largest declines in cancer deaths from 2000 to 2009, though their cancer death rates from 2005 to 2009 were still highest when compared to other racial groups.

Though death rates for cancers such as lung cancer , breast cancer, and colon cancer are declining, the rate of diagnoses for some cancers is increasing. The rate of new cases of pancreas, kidney, thyroid, liver, melanoma, and myeloma cancers have all increased in men from 2000 to 2009. For women, rates of new cases of thyroid, melanoma, kidney, pancreas, liver, leukemia, and uterus cancers increased during the same period. The report points out that excess weight and lack of physical activity are risk factors for many of these cancers.

“The continuing drop in cancer mortality over the past two decades is reason to cheer,” said John Seffrin, CEO of the American Cancer Society. “The challenge we now face is how to continue those gains in the face of new obstacles, like obesity and HPV infections. We must face these hurdles head on, without distraction, and without delay, by expanding access to proven strategies to prevent and control cancer.”

A special section of the report highlighted trends related to human papillomavirus (HPV)-associated cancers. From 2000 to 2009, HPV-associated oropharyngeal (throat) cancer rates increased among white men and women, while anal cancer rates among all men and women increased. Rates of vulva cancer were up among women, though cervical cancer rates declined among all women except Native Americans. The report shows that fewer than one-third of girls aged 13 to 17 had received all 3 recommended doses of the HPV vaccine. Girls in the Southern U.S., those who live in poverty, and those who are hispanic were less likely to get all three doses.

“While this report shows that we are making progress in the fight against cancer on some fronts, we still have much work to do, particularly when it comes to preventing cancer,” said Dr. Thomas Frieden, Director of the U.S. Centers for Disease Control and Prevention (CDC). “For example, vaccinating against HPV can prevent cervical cancer, but, tragically, far too many girls are growing into adulthood vulnerable to cervical cancer because they are not vaccinated.”

January, 2013|Oral Cancer News|

Team approach improves oral cancer outcomes

Author: Donna Domino, Features Editor

Providence Cancer Center in Portland, OR, is one of a growing number of facilities that is working to improve care for patients with oral cancer and head and neck cancers through a multidisciplinary program that brings together a spectrum of treatment providers.

To illustrate the challenges many oral cancer patients face, R. Bryan Bell, MD, DDS, medical director of the Oral, Head and Neck Cancer Program at Providence, described the extreme effects the illness and its treatment had on one of his patients. The woman had undergone surgery, chemotherapy, and radiation for her oral cavity cancer.

“This was a beautiful 32-year-old woman who had lost all her teeth and couldn’t chew,” Dr. Bell told “She had aged about 40 years during treatment, and she just looked awful. But she had no means of affording needed dental rehabilitation, which would have cost about $60,000. People need to see what happens when you don’t restore these patients.”

Dr. Bell used the woman’s case to convince officials at Providence Health, which oversees the medical center, of the need for a multidisciplinary approach for these patients. The new cancer treatment center, which opened last month, is a unique collaboration between dental and medical oncology specialists.

The center provides coordinated care for oral cancer patients who often need expensive and complex dental rehabilitation, regardless of their ability to pay, according to Dr. Bell. His team includes head and neck surgical oncologists, radiation oncologists, medical oncologists, otolaryngologists, neuro-otologists, and a maxillofacial prosthodontist. The hospital gets some money from Medicaid, but the program is aided by the fact that Providence is one of the biggest healthcare providers in the U.S.

“That’s what really makes us unique,” Dr. Bell explained. “We’re integrating dentistry into the multidisciplinary head and neck cancer treatment team.” In fact, Oregon is at the forefront of implementing coordinated care organizations, which are designed to deliver Medicaid services throughout the state, he added.

The unusual approach bridges the gap for patients dealing with the broad-ranging aftereffects of cancers of the oral cavity, head, and neck.

“We have a disconnect in this country regarding medical and dental care, and it’s particularly acute regarding cancer patients,” Dr. Bell observed.

Most people have affordable access to care for common dental procedures such as restorations and root canals, he noted, but oral cancer patients often need extensive and expensive oral treatment.

“A majority of patients undergoing head and neck cancer treatment, and cancer treatment in general, will have some sort of oral health problem, and many need significant dental care — whether it’s as simple as a filling or crown or as complicated as bone graft reconstruction with implant supported prosthetic rehabilitation,” Dr. Bell said. “For many of these patients, the price tag is in excess of $40,000 to $50,000.”

Changing risk factors
The Providence center treats more than 200 head and neck cancer patients annually; of these, about 150 involve cancers of the oral cavity. The youngest oral cancer patient was 19, and the oldest was 100, Dr. Bell said.

Becky Roth, 49, is one of a growing number of patients that Dr. Bell sees who develop oral cancer despite having no traditional risk factors, such as smoking and drinking. Surgeons removed most of her tongue and the lower segment of her mandible. Microvascular surgery was done to harvest her fibula to reconstruct her mandible; her second fibula was removed when Roth’s cancer recurred. A titanium plate was used to hold the fibula in place.

“We take a large segment of fibula bone with the muscle, soft tissue, and skin attached to it and do some carpentry on it to fashion it in the shape of a mandible as best we can,” Dr. Bell explained.

Surgeons often use the fibula osteocutaneous free flap, which is very common in head and neck centers, he added.

Despite losing both fibulas, Roth has been able to resume one of her passions — running — and has posted some of her personal best times. “She’s just a remarkable person,” Dr. Bell said.

Dr. Bell has noticed a growing number of oral cancer patients, particularly with cancers in the oropharynx and oral cavity. “That’s where we’re really seeing a difference in the change of demographics,” he said. “We’re seeing more younger patients — men and women who never smoked or rarely drank alcohol, like Becky.”

The majority of patients with oropharyngeal cancer have human papilloma (HPV)-driven cancers, but that’s not necessarily the same with oral cavity cancer, he noted.

“It is clear from data that HPV is a sexually transmitted disease, it is clear that HPV causes oropharynx cancer, and it is clear the risk for developing HPV-driven oropharynx cancer increases with the number of sexual partners,” he said. “But presumably people have been having oral sex longer than the last 15 years. Just because we haven’t identified what else is involved doesn’t mean there are no other contributing factors.”

Dr. Bell supports the use of HPV vaccines for young girls and boys. “I have an 8-year-old son, and I’ll certainly get him vaccinated in the next six or seven years.”

New technology, new treatments
New technology and multidiscipline treatments have vastly improved the quality of life for oral cancer patients, Dr. Bell pointed out.

“I think that’s where we’ve really come a long way in the last couple of decades,” he said. “While we’ve made only modest improvements in overall survival rates — 58% of such patients will be alive in five years, which hasn’t changed much in the last 50 years — where we have made tremendous strides is in our ability to restore patients to form and function. Patients are now living longer with their cancer, and they’re living much more functional lives.”

Dr. Bell described how improved treatments have affected patients like Roth. “We can remove two-thirds of her mandible and reconstruct it with vascularized tissue and implants, and give her teeth to chew with, to speak with, to swallow — all those things,” he said.

New technology and surgical methods are decreasing the adverse effects of chemotherapy and radiation therapy in a personalized way, he added.

“We’re trying to match the disease with the cure,” he said — by using robotic surgery, for example.

“We are now able to approach tumors in the back of the throat and base of the tongue with a surgical robot in a manner that used to take a much larger operation and splitting the jaw,” Dr. Bell explained.

Transoral robotic surgery (TORS) has allowed reduced doses of radiation therapy and even the elimination of chemotherapy in a significant number of patients, he noted. Dr. Bell was among the first surgeons in Oregon to use TORS after it was approved by the U.S. Food and Drug Administration.

One area that still needs improvement, however, is the routine refusal of most insurers to cover the dental care many oral cancer patients need.

“If you have your leg cut off from sarcoma, Medicaid, Medicare, or medical insurance would invest the $40,000 or $50,000 to give that patient a prosthesis,” he said. “So why doesn’t that occur in the oral cavity just because it’s a dental problem? Patients and healthcare providers need to be advocates to our policymakers to carve these areas out of dentistry.”

January, 2013|Oral Cancer News|

Quitting smoking before cancer surgery best, study finds

Author: staff

Cancer patients who smoked up until their surgery were more likely to take up the habit again compared to those who quit earlier, a new study finds.

The study from the Moffitt Cancer Center in Tampa, Fla., included lung cancer and head and neck cancer patients who quit smoking before or immediately after surgery. They were followed for a year after the surgery.

“Sixty percent of patients who smoked during the week prior to surgery resumed smoking afterward, contrasted with a 13 percent relapse rate for those who had quit smoking prior to surgery,” study corresponding author Vani Nath Simmons said in a Moffitt news release.

The significantly lower smoking relapse rate for those who quit smoking before surgery shows the need to encourage patients to quit smoking when they’re diagnosed with cancer, the researchers said.

The investigators also noted that most of the patients who began smoking again did so shortly after surgery, which shows the importance of anti-smoking programs for patients both before and after surgery.

The study also found that patients were more likely to resume smoking if they had a high amount of fear about cancer recurrence, had a higher risk for depression, and were less likely to believe in their ability to quit smoking.

“Cancer patients need to know that it’s never too late to quit,” Simmons said. “Of course, it would be best if they quit smoking before getting cancer; but barring that, they should quit as soon as they get diagnosed. And with a little assistance, there is no reason that they can’t succeed.”

January, 2013|Oral Cancer News|

Erbitux add-on falls short in esophageal cancer

Author: Charles Bankhead, Staff Writer, MedPage Today

The addition of a targeted agent to definitive chemoradiation failed to improve survival in an unselected population with esophageal cancer, a randomized trial showed. In fact, patients who received cetuximab (Erbitux) with chemoradiation had significantly worse overall survival (OS) reflected in a 50% increase in the hazard versus chemoradiation alone, reported Thomas Crosby, MD, of Velindre Hospital in Cardiff, Wales, and colleagues.

Investigators could not find any subgroup of patients who benefited from cetuximab, they said in a presentation at the Gastrointestinal Cancers Symposium.

“The addition of cetuximab cannot be recommended to standard definitive chemoradiotherapy in the treatment of unselected patients with esophageal cancer,” Crosby said.

“The use of high-quality definitive chemoradiotherapy in the treatment of localized, poor-prognosis esophageal cancer was associated with excellent survival compared with previous radiotherapy and surgical series,” he added.

Randomized trials have shown that definitive (or primary) chemoradiation improves survival in localized esophageal cancer compared with a single treatment modality. In England, definitive chemoradiation has been used primarily for patients with localized disease that is unsuitable for surgery, Crosby said.

Add-on therapy with cetuximab has improved outcomes in other cancers, notably head and neck cancer and colorectal cancer. The findings provided a rationale for evaluating the addition of cetuximab to primary radiation therapy for localized esophageal cancer.

Crosby presented results of a randomized trial wherein patients with localized (stage I-III) esophageal cancer (less than 10 cm). Patients were excluded if they had celiac lymph-node involvement.

The patients received cisplatin-capecitabine (Xeloda) chemotherapy with or without cetuximab. After 6 weeks of chemotherapy, patients underwent definitive conformal radiation therapy at a total dose of 50 Gy in 25 fractions.

The trial had two stages. The first stage had a primary endpoint of treatment failure-free survival (TFFS), defined as alive at 6 months with no residual cancer in biopsy specimens and no evidence of disease progression outside the radiation therapy field. Secondary endpoints were toxicity, quality of life, overall survival (OS), and feasibility of recruitment. The first stage of the trial had an accrual target of 180 patients.

The trial’s second stage had a primary endpoint of OS and accrual to 420 patients.

However, the trial never reached second stage, but ended after a planned stage one analysis convinced the independent review committee that continued accrual to meet the primary endpoint would be futile.

Treatment and follow-up continued with enrolled patients, and the final analysis included 258 patients who had completed the 6-month assessment of disease status.

Crosby reported that patients randomized to conventional chemoradiation without cetuximab had a TFFS of 77% whereas the cetuximab group had a TFFS of 66%. All survival outcomes favored omission of cetuximab:

Median OS: 25.4 months versus 22.1 months
2-year survival: 56% versus 43.1%
Median progression-free survival: 19.4 months versus 15.9 months
The analysis showed a marked difference in median OS between patients who met the TFFS goal at 6 months and those who did not: 26.7 months versus 8.3 months.

Comparison of OS in the two arms yielded hazard ratio of 1.53 for the cetuximab arm versus chemoradiation only (P=0.035).

In addition to the inferior outcomes with cetuximab, addition of the targeted agent added to the toxicity burden. The cetuximab arm had an 81.4% incidence of grade 3 to 5 toxicity compared with 72.9% without cetuximab.

Patients who received cetuximab in addition to chemoradiation had significantly more grade 3 to 5 dermatologic toxicity (21.7% versus 3.9%, P<0.001) and metabolic/biochemical toxicity (24.0% versus 10.9%, P=0.005).

Additionally, the analysis revealed a trend toward more cardiac adverse events in the cetuximab arm (6.2% versus 1.6%, P=0.053).

The addition of cetuximab also adversely affected adherence to the treatment protocol. Patients in the cetuximab arm were significantly less likely to receive full doses of cisplatin (76.7% versus 89.9%, P=0.005), capecitabine (69.0% versus 85.3%, P=0.002), and radiation therapy (75.2% versus 86.0%, P=0.027).

Additionally, almost a third of patients did not receive the prescribed dose of cetuximab.

“Future strategies to improve the outcome of definitive chemoradiotherapy in esophageal cancer must focus on developing evidence-based biomarkers to select treatments and incorporating newer radiotherapy technologies and targeted systemic treatment to safely intensify treatment, including a higher radiotherapy dose,” Crosby said.

January, 2013|Oral Cancer News|

Should You Get the HPV Vaccine?

You don’t have to be a virgin to be protected against cancer.

By |Posted Friday, Jan. 25, 2013, at 1:22 PM ET

Source: Slate

A doctor gives a 13-year-old girl an HPV vaccination

A doctor gives a 13-year-old girl an HPV vaccination
Photo by Joe Raedle/Getty Images.

The human papillomavirus has the dubious distinction of being the sexually transmitted disease you are most likely to get. It’s also the leading cause of cervical cancer. January has, somewhat arbitrarily, been dubbed Cervical Health Awareness Month (also National Hobby Month and Hot Tea Month, the last at least for good reason). While cervical cancer is the disease most commonly associated with HPV, a recent report from the American Cancer Society emphasizes that HPV’s threat is not gender-specific or organ-specific. While cervical cancer cases are in decline (as are general cancer rates), cancers linked to HPV are on the rise.

The increasing prevalence of HPV-linked cancers should permanently alter our limited conception of the disease as chiefly a women’s issue. Oropharyngeal (which I’ll be vulgarizing as “oral”) and anal HPV-related cancers (which particularly afflict men who have sex with men) are becoming more common. Oral malignancies account for 37.3 percent of HPV-related cancers, edging out cervical cancer, which makes up 32.7 percent. For men, oral cancers make up 78.2 percent of total HPV-related cancer incidences, and they account for 11.6 percent of cases among women. The death rate for oral cancer is three times higher than that for cervical cancer. (About 40 percent of penile cancer cases are HPV-related, but rates of the disease have basically remained static.)

Historically, most oral cancer cases were caused by smoking and heavy drinking and tended to manifest later in life. But even though fewer Americans indulge in these vices today, more of them are engaging in oral sex. Oral cancer rates have risen and begun showing up in younger individuals who, sensibly, seem to prefer oral sex to cigarettes. As the Oral Cancer Foundation notes, HPV strain 16 “is conclusively implicated in the increasing incidence of young non-smoking oral cancer patients.” If the disease is detected, the survival rate for HPV-related oral cancer is higher than for the alcohol- and tobacco-correlated versions. But HPV-related cases are often harder to catch because the disease occurs deeper in the mouth (the base of the tongue is a common location), and the warning signs are not as obvious.

There are, of course, HPV vaccines, which the CDC describes as “very effective” and “very safe.” Merck released another study in October that found that Gardasil, the company’s vaccine, may cause fainting and brief skin irritation but “no link with more serious health problems was found.” The Gardasil vaccine defends against four HPV strains: 6 and 11, which cause 90 percent of genital warts; and 18 and 16, which are linked to cancer. It is FDA-approved and CDC-recommended for males and females. Cervarix defends against the same two cancer-causing strains and a few other lesser culprits. It is not licensed for men. Most insurance companies and public health programs will cover the cost of the HPV shots for those who fall between the FDA-licensed ages of 9 through 26 years old.

But while both vaccines successfully defend against various strains of HPV, only Gardasil has been specifically tested and proven to protect against vulvar, vaginal, and anal cancers as well as cervical cancer. The vaccines’ preventive abilities have not been proven for other cancers, which prevents the companies from advertising the vaccines’ usefulness against the most prevalent danger: HPV-related oral disease. As the CDC notes: “It is likely that this vaccine also protects men from other HPV-related cancers, like cancers of the penis and oropharynx (back of throat, including base of tongue and tonsils), but there are no vaccine studies that have evaluated these outcomes.” Last year the National Cancer Institute declined to fund proposed clinical trials on the efficacy of the vaccines for oral cancer, possibly due to budgetary constraints. (NCI officials were not able to respond before publication.)

“The very low rate at which boys are vaccinated is a result of the inability of the manufacturers and doctors to speak openly and with factual evidence about oral cancer in a context that parents will understand,” says Brian Hill, president of the Oral Cancer Foundation, who was present at the National Institute of Health meeting where the aid was requested. He says more data and publicity for the vaccines could improve the vaccination rate in boys, which in 2010 was only 1.4 percent. “Vaccination is not just about cervical cancers but cancers their sons will potentially get in the future.”

The dangers of HPV may sound pretty disturbing, particularly for those who might have shrugged off the virus’s threat because they believed it wouldn’t imperil them or their children. But there are a few important things to understand about HPV. First, we aren’t all doomed. A lot of scary statistics get batted around about HPV—6 million new infections a year! Half of sexually active people will get it in their lives!—but most of the 130-plus strains appear to do no damage, and most people’s immune systems recognize the handful of dangerous strains as something nasty that should be destroyed.

But an unlucky 1 percent of the population will not produce the antibodies necessary to defeat the invaders. And it is basically impossible to know whether you or one of your partners is part of that 1 percent. There isn’t a reliable blood test to tell whether your body is making antibodies against the virus and is thus protected naturally and you don’t need the vaccine.

The vaccines work best in those who have never had sex and therefore have never been exposed to any strain of the virus. That means the safety and efficacy of the vaccines are of limited comfort to those who were sexually active prior to 2006, when the vaccine first became available to females (in 2009 males were officially given the OK).

After a certain age, 26 in the United States, it is assumed most people have had enough sexual partners that they have been exposed to HPV and their bodies have produced the antibodies necessary to defeat it on their own. In the case of women who have been exposed and developed an infection, it is thought that cervical abnormalities will have been detected and dealt with. Vaccinating people after a long sexual history simply isn’t worth the cost, from a public health perspective.

But age isn’t always a reliable measure of sexual activity, particularly for those who, say, married young and are getting a divorce and re-entering the dating scene. “If you vaccinate a 45-year-old woman who hasn’t had a cervical HPV, the vaccine will work for her as well,” says Aimée R. Kreimer of the National Cancer Institute. One study shows the vaccines, which guard against multiple varieties of the virus, can be effective in older women who have not been previously exposed to all of the targeted strains. Another study even suggests that the vaccine prevents further HPV outbreaks among women who have already been treated for cervical infection. “Our findings clearly show that those who have the disease can be protected from new disease and dispels the myth that only young and virgin girls can benefit from the vaccine,” says Elmar A. Joura of the Medical University of Vienna and an author of a study published last year in the British Medical Journal. “The earlier you vaccinate the better, but the benefit never really stops. It prevents new infections for sure, independent of age.”

Unfortunately, the decision about whether to get vaccinated or not isn’t a simple one. Gardasil and Cervarix have no therapeutic properties, and once someone has caught one of the strains, the vaccine is no longer protective against that particular infection. There is no reliable blood test to show which HPV strains someone has been exposed to, so it is always possible that the vaccine could be beneficial—or not. But overall, the longer someone has been sexually active, the less likely the vaccine will be of use, which is why public health campaigns focus on the young.

Most nations with universal health care also have rigorous cost-control measures and do not cover the HPV vaccine for people in their 20s. The exact age varies: In the United Kingdom vaccinations are free for those 11 to 17 years old. In Canada, where vaccination programs are run by the provinces, free shots are chiefly available to school-aged women. The same is true in most European nations. Studies like Joura’s have inspired many countries to raise their age recommendations beyond America’s 9 to 26 years old—Canada suggests the vaccine for women up to the age of 45—but those who aren’t covered by the public vaccination programs have to pay for it themselves. “This [hypothetical older] woman is probably not cost-effective in a vaccination program, but when she is looking for the personal benefit she clearly gets it,” Joura says.

America’s patchwork of private and public providers are often more generous with free vaccinations than are health care systems in other developed nations. Many insurance companies will cover the cost of the shots for those up to the age of 26, as will many publicly funded programs for children, and in some states adults, without private insurance.

The FDA’s age-licensing limitations or the CDC’s age recommendations do not mean that it is a bad idea for those older than 26 to get the HPV vaccine. But the cost of the vaccine in most cases has to be paid out of pocket, to the tune of about $390 to $500. Is it worth it? That’s a personal judgment call. The fewer sexual partners you’ve had, the less likely it is that you’ve already been exposed to the HPV strains the vaccine defends against. If you anticipate having new partners (potentially with new virus strains you haven’t been exposed to before), you may well still benefit from the vaccine.

For people who haven’t encountered all of the HPV strains in the vaccine, says Alex Ferenczy of McGill University, “the efficacy of the vaccine is still outstanding for those remaining virus types to which they were not exposed before the vaccination.”

One more reason to consider the vaccine is that it is unclear whether antibodies, either induced by an actual HPV infection or the vaccine, have a half-life. That means protection may not last forever. This is true of other antibodies: The immunity conferred by a childhood brush with chickenpox may not last to protect us from shingles, which is caused by the same virus, later in life. It is known that vaccine-induced antibodies or those produced naturally in reaction to an HPV infection last 10 years. But they have not been proven to last a lifetime. If they don’t last, this is another possible reason why the vaccine could be effective in women in their 40s, but there is not enough research to prove or disprove this premise.

The vaccine is most useful for young people who are least likely to have been exposed. But by this measure, America is failing. Due to our long history of anti-vaccine hysteria, and some conservative politicians’ perennial efforts to politicize anything remotely related to sex, HPV vaccination rates in the United States are terribly low. Only 32 percent of girls ages 13 to 17 have received the full three-shot regimen, which is significantly less than in Canada, Great Britain, and some regions of Mexico (although much of the European Union has similarly dismal rates). Like most health issues in the United States, HPV’s worst consequences are unequally distributed, with cervical, anal, and penile cancer rates all higher among lower-income populations who tend to be poorly covered by insurance programs and have less access to health care.

For those who are under 26, getting vaccinated will likely be free. Since it is impossible to know how effective the vaccine may be in your case, it’s worth getting—it won’t hurt you or your wallet. For those over 26, vaccination can be an expensive decision, but it may well be worth it, particularly if you haven’t had many sexual partners or are expecting new ones. But to get the most bang for our public health buck, America needs to muster the political will to establish HPV vaccination programs for schoolchildren, both boys and girls. We already require vaccination of children against another sexually transmitted infection before they enter school: hepatitis B. HPV vaccination is an easy and safe way to spare kids a lot of pain and fear later in life.


* This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.


Scientists find new way to boost cancer drugs

Author: DrBicuspid Staff

Shutting down a specific pathway in cancer cells appears to improve the ability of common drugs to wipe those cells out, according to new research from scientists at Fox Chase Cancer Center (Cancer Discovery, January 2013, Vol. 3:1, pp. 96-111).

The new approach appears to enhance the tumor-killing ability of a commonly prescribed class of drugs that includes cetuximab (Erbitux), used to treat head and neck cancers. These drugs work by blocking the activity of the epidermal growth factor receptor (EGFR), which sits on the cell surface and senses cues from the environment, telling cancer cells to grow and divide, according to co-author Igor Astsaturov, MD, PhD, an attending physician in the department of medical oncology at Fox Chase.

In 2010, Dr. Astsaturov and his colleagues identified a pathway in the cell that, when blocked, completely suppressed EGFR activity. Interestingly, the pathway consists of a series of enzymes that, when working in concert, synthesize new molecules of cholesterol.

Working with cancer cells in the lab, the researchers inactivated a key gene in the cholesterol synthesis pathway, and found the cells became more vulnerable to treatment with cetuximab. The same was true in mice that lacked this particular pathway, according to Dr. Astsaturov.

“Most tumors are only moderately sensitive to inhibitors of EGFR, but when these tumors lack an essential gene in the cholesterol pathway, they become exquisitely sensitive to the anti-EGFR drugs,” he said. “The cancers literally melt away in mice.”

The researchers then removed one of the cholesterol genes from the mouse genome and saw that mice developed patchy, scaly skin. When they biopsied this affected skin, they saw no activity of the EGFR protein, reaffirming that shutting down cholesterol synthesis interrupts EGFR.

When the cholesterol biosynthesis pathway is blocked, the normal chain of events that creates a cholesterol molecule is interrupted, and cells accumulate intermediate products of cholesterol that block the normal movement of substances around the cell, according to the researchers. This cellular traffic jam makes it difficult for the cell to transport important components, such as EGFR, which has to move between the inside of the cell and its surface to function properly.

Eventually, researchers can design drugs or look for existing ones that block this cholesterol synthesis pathway, Dr. Astsaturov noted. For now, his lab is trying to uncover more details of how the pathway works, the role of each protein that is involved, and whether if, by blocking a protein, they can wipe out tumors in humans that evade current therapies.

January, 2013|Oral Cancer News|

‘Dentist should have spotted my cancer’

Author: staff

An NHS dentist who advised a patient to treat what turned out to be a life-threatening oral cancer with mouthwash is being sued for tens of thousands of pounds in damages.

Paula Drabble, 58, went to Pinfold Dental Practice, in Hattersley, Hyde, in June 2008 with concerns about a white lesion on her gum.

She was told by her dentist, Ian Hughes, it was nothing serious, a court heard.

Mrs Drabble of Mottram Moor, Mottram, Hyde, had five further appointments with Mr Hughes and was advised to ‘manage’ her complaint with mouthwash. She was eventually referred to hospital in April 2009, and ‘seriously invasive cancer’ diagnosed.

She had surgery, including removal of affected bone, followed by radiotherapy and chemotherapy.

She has now made a good recovery and has begun a High Court fight for damages, claiming Mr Hughes was negligent to have not spotted the cancer and referred her to hospital earlier. Timothy Briden, for Mrs Drabble, told the court his client had developed the patch on her gum some years earlier. The lesion was found to be benign by medics at the University Dental Hospital in Manchester and she was discharged in 2004 with a letter being sent to Mr Hughes, warning him to ‘re-refer if you notice or indeed Mrs Drabble notices any changes’.

Marcus Dignum, for Mr Hughes, denied that his client was at fault in failing to spot the cancer. He said: “Plainly the court will have every sympathy with Mrs Drabble in respect of her ordeal, as does Mr Hughes, but the allegations made against him are extremely serious from both a personal and professional standpoint. They are vigorously denied.

“In June 2008 the presence of the cancer would not have been detectable with the human eye, as its presence would have been at a cellular level only.”

January, 2013|Oral Cancer News|

HPV vaccine issue returns to legislature


Date: January 14, 2013

by Stacy Jacobson

CHARLESTON, S.C. (WCIV) — A local state representative will introduce a bill that would give middle school students better accessibility to information about the Human Papilloma Virus vaccine and to the vaccine itself.

Gov. Nikki Haley vetoed the bill last year. But lawmakers wanted to try again.

HPV can cause cervical cancer, as well as head and neck cancer, doctors said.

Therese Speer is a mother of three, and grandmother of four. She knew what it was like to worry as a parent.

“More information is always a benefit to parents. The more you know, the more informed decision you can make,” Speer said.

She said she supports a new bill called the Cervical Cancer Prevention Act. Rep. Bakari Sellers (D-90th District) proposed it.

“The CDC just stated the cost of cervical cancer in South Carolina is upwards of $25 million. This is something we can head off,” Sellers said.

The bill would make information about the HPV vaccine more available to seventh grade students. The bill would also allow the South Carolina Department of Health and Environmental Control to offer the vaccine through school.

“When that information is provided and parents have opportunity to speak to pediatrician about this vaccine, they overwhelmingly accept it,” MUSC gynecologic oncologist Dr. Jennifer Young-Pierce said.

Officials said the bill had no mandates, only options.

“Too often, people get info from friend or Internet that doesn’t have the most up-to-date information. This is requiring us to provide information to our children’s parents,” Young-Pierce said.

Sellers said only eight states other than South Carolina have fewer deaths from cervical cancer.

Former first lady and mother of four Jenny Sanford said the bill would also save the state money.

“I think it just makes good budget sense. I think the numbers I’ve seen are to vaccinate the population, it might be $1 million or $1.5 million total. And yet, we already spend $6 to $10 million treating that same population,” Sanford said.

Speer said awareness was all she could ask for as a parent.

“I say get the information out there, in the hands of people who need to make decisions,” she said.

Doctors also said boys should get the vaccine because they carry HPV. They also said the Centers for Disease Control ruled the vaccine safe.

Officials said the cost of the information component will be around $200,000. Most children are covered by insurance, officials said.


*This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

January, 2013|Oral Cancer News|

Dysphagia after definitive radiotherapy for head and neck cancer

Source: Strahlentherapie und Onkologie



Dysphagia is a complication of head and neck cancer patients undergoing radiotherapy (RT). We analysed frequency and severity of swallowing dysfunction and correlated these findings with dose–volume histograms (DVHs) of the pharyngeal constrictor muscles.


A total of 50 patients treated by radical RT were enrolled. DVHs of constrictor muscles were correlated with acute and late dysphagia and with the items of three quality of life questionnaires.


Mean dose to superior and middle constrictor muscles (SCM, MCM), partial volume of SCM and MCM receiving a dose ≥ 50 Gy dose to the whole constrictor muscles ≥ 60 Gy and tumour location were associated to late dysphagia at univariate analysis. Mean dose to the MCM was the only statistically significant predictor of late dysphagia at the multivariable analysis.


The study shows a significant relationship between long-term dysphagia and mean doses to SCM, MCM, whole constrictor muscles, and oropharyngeal tumour. This finding suggests a potential advantage in reducing the RT dose to swallowing structures to avoid severe dysphagia.

 This article was sourced by The Oral Cancer Foundation and vetted for accuracy and appropriateness.
January, 2013|Oral Cancer News|

Why can’t doctors tell cancer patients the truth?


By: Mary Elizabeth Williams

    Medical journals and physicians underplay what treatment is really like. And it hurts patients

Everyone appreciates a bright perspective, especially in grim circumstances. But you know what’s a really poor arena for downplaying the bad news? Medicine.

A new report in the Annals of Oncology this week reveals that in two thirds of breast cancer studies, side effects were downplayed – including serious ones. And, as Reuters reports, it’s a field-wide problem in the health care industry: Last fall, cardiology journal editors warned authors to “watch their language” in reporting, and pediatrics researchers warned of “spin and boasting” in their journals.

Aside from the ethical issues of publishing misleading information, the habit of rushing to make it all seem better has serious consequences. Because the sunnyside talk doesn’t stop at the journals. It trickles over to doctors, who then minimize what a patient’s real experience is going to be like.

And even without overly optimistic literature to inspire them, doctors and their lack of understanding can be an issue. A 2007 study in the journal Drug Safety found that over 60 percent of patients who complained of side effects to a particular drug said “their doctors did not appreciate the impact the symptoms had on their quality of life.” At the time, health policy professor Albert W. Wu told American Medical News that doctors “have the bad habit of discounting patients’ complaints. In our desire not to worry patients unduly, to persuade them to take their medications as directed, and perhaps because we are pressed for time, we may at times dismiss the problems they mention.” Yeah, now tell those of us who’ve ever been to the doctor something we don’t know.

There are a whole mess of problems with doctors misleading patients, however unintentionally they may be doing it, about the potential side effects of treatments, drugs or procedures — and then undervaluing their patients’ complaints when they kick in. It isn’t just that it sets up patients for more than they may be prepared to bite off. It isn’t just that when you underplay side effects and symptoms, you risk ignoring serious health problems. It’s also that it’s so goddamn frustrating. It’s a built-in guilt trip for patients, who wonder why they’re having a hard time when they’re ostensibly not supposed to be. It pressures them to feel as if they shouldn’t complain. It makes them feel like failures for not being good or doing it right. It makes them question what they’re going through. And it encourages them to play along with one of the great abiding fictions of illness – that it’s all okay; that everything’s fine.

This can lead to extreme – and very painful consequences. Earlier this week, I had a conversation with a man who’s talked to a lot of palliative and hospice care workers in his time. He told me how all of them have stories about hospital patients dying in agony in emergency rooms because their caregivers — from family to doctors — hadn’t been able to accurately acknowledge the reality of the patients’ health situations. They hadn’t been seeing what was really going on. They hadn’t, at times, been listening.

In a beautiful and tough New York Times story Thursday, Abby Goodnough introduced readers to Martha Keochareon, a 59-year-old nurse with late-stage pancreatic cancer who offered herself as a subject for a study for other nurses on end-of-life care. In it, Goodnough talked about how Keochareon’s doctors initially “dismissed as psychosomatic” her complaints of abdominal pain. At the end of her life, she wanted to teach health care professionals “to just dig a little deeper — you know?”

This is a spectacularly important lesson for all of us, because it’s very hard to get by in a culture that minimizes the patient experience and treats pain as if it’s something shameful. There’s a pervasive cheerleaderism to modern medicine – a rah-rah-you-can-beat-this-and-it’s-not-so-bad-right? attitude that can be exhausting and demoralizing. So here’s the truth: the physical and inevitable subsequent emotional effects of illness and the medicines we use to treat them are real and they’re frequently horrible. They’re distracting and depressing and scary. And it’s necessary to say that.

I have friends who have done chemo and surgery and other treatments for various ills who now say they’re done because it was so bad and they’re not going back. And I wonder if it would have been different if their doctors had just said to them initially, “This is going to suck” — if, instead of assuming that patients will always grasp at any straw to live a little longer, the doctors had found the courage to have some honest quality of life conversations.

In the Times story, Goodnough quotes nurse Pam Malloy, who admits, “We live in a death-denying society.” A death-denying, pain-denying one. But pain and death happen. Ignoring them doesn’t make them go away. Doing so is a placebo that only adds needlessly to suffering. And while the truth never cured anybody, it is a remarkably healing thing.


This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

January, 2013|Oral Cancer News|